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Beta Amyloid Aggregation Inhibitors: Small Molecules as Candidate Drugs for Therapy of Alzheimers Disease

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The progressive production and subsequent accumulation of β-amyloid (Aβ), a proteolytic fragment of the membrane-associated amyloid precursor protein (APP), plays a central role in Alzheimer's Disease (AD). Aβ is released in a soluble form that may be responsible for cognitive dysfunction in the early stages of the disease, then progressively forms oligomeric, multimeric and fibrillar aggregates, triggering neurodegeneration. Eventually, the aggregation and accumulation of Aβ culminates with the formation of extracellular plaques, one of the morphological hallmarks of the disease, detectable post-mortem in AD brains. In this review we report the known structural features of amyloid peptides and fibrils, and we give an overview of all small molecules that have been found to interact with Aβ aggregation. Deeper knowledge of the mechanism leading to amyloid fibrils along with their molecular structure and the molecular interactions responsible for activity of small molecules could supply useful information for the design of new AD therapeutic agents.
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... Therefore this model could in principle be expanded to also simulate the impact of novel amyloid therapies-many already in early clinical development-with different targets for instance focused solely on oligomers, 24 gamma-secretase modulators, 25 or with small molecules affecting the aggregation rate of Aβ species. 26,27 Based on the consensus that amyloid antibody therapy is best terminated after reaching amyloid negativity, we first simulated the time to Along the same lines, the virtual patient trial suggests that at 18 months, 78%, 72%, and 57% respectively of patients in the donanemab, lecanemab, and aducanumab trial were amyloid-negative. This is in accordance with reported clinical data of 71% for donanemab, 31 >75% ...
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INTRODUCTION Addressing practical challenges in clinical practice after the recent approvals of amyloid antibodies in Alzheimer's disease (AD) will benefit more patients. However, generating these answers using clinical trials or real‐world evidence is not practical, nor feasible. METHODS Here we use a Quantitative Systems Pharmacology (QSP) computational model of amyloid aggregation dynamics, well validated with clinical data on biomarkers and amyloid‐related imaging abnormality–edema (ARIA‐E) liability of six amyloid antibodies in clinical trials to explore various clinical practice challenges. RESULTS Treatment duration to reach amyloid negativity ranges from 12 to 44, 16 to 40, and 6 to 20 months for lecanemab, aducanumab, and donanemab, respectively, for baseline central amyloid values between 50 and 200 Centiloids (CL). Changes in plasma cerebrospinal fluid Aβ42 and the plasma Aβ42/ Aβ40 ratio—fluid biomarkers to detect central amyloid negativity—is greater for lecanemab than for aducanumab and donanemab, indicating that these fluid amyloid biomarkers are only suitable for lecanemab. After reaching amyloid negativity an optimal maintenance schedule consists of a 24‐month, 48‐month and 64‐month interval for 10 mg/kg (mpk) lecanemab, 10 mpk aducanumab, and 20 mpk donanemab, respectively, to keep central amyloid negative for 10 years. Cumulative ARIA‐E liability could be reduced to almost half by introducing a drug holiday in the first months. For patients experiencing ARIA‐E, restarting treatment with a conservative titration strategy resulted in an additional delay ranging between 3 and 4 months (donanemab), 5 months (lecanemab), and up to 7 months (aducanumab) for reaching amyloid negativity, depending upon the timing of the incident. Clinical trial designs for Down syndrome patients suggested the same rank order for central amyloid reduction, but higher ARIA‐E liability especially for donanemab, which can be significantly mitigated by adopting a longer titration period. DISCUSSION This QSP platform could support clinical practice challenges to optimize real‐world treatment paradigms for new and existing amyloid drugs.
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Alzheimer’s β amyloid protein (Aβ) is a 39 to 43 amino acid peptide that is a major component in the neuritic plaques of Alzheimer’s disease (AD). The assemblies constituted from residues 25–35 (Aβ25–35), which is a sequence homologous to the tachykinin or neurokinin class of neuropeptides, are neurotoxic. We used X-ray diffraction and electron microscopy to investigate the structure of the assemblies formed by Aβ25–35 peptides and of various length sequences therein, and of tachykinin-like analogues. Most solubilized peptides after subsequent drying produced diffraction patterns characteristic of β-sheet structure. Moreover, the peptides Aβ31–35 (Ile–Ile–Gly–Leu–Met) and tachykinin analogue Aβ(Phe31)31–35 (Phe–Ile–Gly–Leu–Met) gave powder diffraction patterns to 2.8Å Bragg spacing. The observed reflections were indexed by an orthogonal unit cell having dimensions of a=9.36Å, b=15.83Å, and c=20.10Å for the native Aβ31–35 peptide, and a=9.46Å, b=16.22Å, and c=11.06Å for the peptide having the Ile31Phe substitution. The initial model was a β strand where the hydrogen bonding, chain, and intersheet directions were placed along the a, b, and c axes. An atomic model was fit to the electron density distribution, and subsequent refinement resulted in R factors of 0.27 and 0.26, respectively. Both peptides showed a reverse turn at Gly33 which results in intramolecular hydrogen bonding between the antiparallel chains. Based on previous reports that antagonists for the tachykinin substance P require a reverse turn, and that Aβ is cytotoxic when it is oligomeric or fibrillar, we propose that the tachykinin-like Aβ31–35 domain is a turn exposed at the Aβ oligomer surface where it could interact with the ligand-binding site of the tachykinin G-protein-coupled receptor.